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Miró Ò, Ivars N, Lopez-Ayala P, Gil V, Llauger L, Alquézar-Arbé A, Jacob J, Rodríguez-Adrada E, Tost J, Mir M, Gil C, Sánchez S, Aguirre A, Martín E, Alonso MI, Garrido JM, López-Grima ML, Lucas-Imbernon FJ, Sánchez C, Escoda R, Gil A, Espinosa B, Wussler D, Peacock WF, Mueller C, Llorens P. Effect of Flu Vaccination on Severity and Outcome of Heart Failure Decompensations. J Card Fail 2023; 29:734-744. [PMID: 36706976 DOI: 10.1016/j.cardfail.2022.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 12/22/2022] [Accepted: 12/28/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To investigate the relationship of seasonal flu vaccination with the severity of decompensation and long-term outcomes of patients with heart failure (HF). METHODS We analyzed 6147 consecutively enrolled patients with decompensated HF who presented to 33 Spanish emergency departments (EDs) during January and February of 2018 and 2019, grouped according to seasonal flu vaccination status. The severity of HF decompensation was assessed by the Multiple Estimation of Risk Based on the Emergency Department Spanish Score in Patients With Acute Heart Failure (MEESSI-AHF) + MEESSI scale, need of hospitalization and in-hospital all-cause mortality. The long-term outcomes analyzed were 90-day postdischarge adverse events and 90-day all-cause death. Associations between vaccination, HF decompensation severity and long-term outcomes were explored by unadjusted and adjusted logistic and Cox regressions by using 14 covariables that could act as potential confounders. RESULTS Overall median (IQR) age was 84 (IQR = 77-89) years, and 56% were women. Vaccinated patients (n = 1139; 19%) were older, had more comorbidities and had worse baseline status, as assessed by New York Heart Association class and Barthel index, than did unvaccinated patients (n = 5008; 81%). Infection triggering decompensation was more common in vaccinated patients (50% vs 41%; P < 0.001). In vaccinated and unvaccinated patients, high or very-high risk decompensation was seen in 21.9% and 21.1%; hospitalization occurred in 72.5% and 73.7%; in-hospital mortality was 7.4% and 7.0%; 90-day postdischarge adverse events were 57.4% and 53.2%; and the 90-day mortality rate was 15.8% and 16.6%, respectively, with no significant differences between cohorts. After adjusting, vaccinated decompensated patients with HF had decreased odds for hospitalization (OR = 0.823, 95%CI = 0.709-0.955). CONCLUSION In patients with HF, seasonal flu vaccination is associated with less severe decompensations.
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Affiliation(s)
- Òscar Miró
- Emergency Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain; The GREAT network, Rome, Italy.
| | - Nicole Ivars
- Emergency Department, Short Stay Unit and Hospitalization at Home Unit, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
| | - Pedro Lopez-Ayala
- The GREAT network, Rome, Italy; Cardiology Department, University Hospital of Basel, Cardiovascular Research Institute Basel, Basel, Switzerland
| | - Víctor Gil
- Emergency Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - Lluís Llauger
- Emergency Department, Hospital Universitari de Vic, Barcelona, Catalonia, Spain
| | - Aitor Alquézar-Arbé
- Emergency Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | | | - Josep Tost
- Emergency Department, Hospital de Terrassa, Barcelona, Catalonia, Spain
| | - María Mir
- Emergency Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Cristina Gil
- Emergency Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Susana Sánchez
- Emergency Department, Hospital Rio Hortega, Valladolid, Spain
| | - Alfons Aguirre
- Emergency Department, Hospital del Mar, Barcelona, Catalonia, Spain
| | - Enrique Martín
- Emergency Department, Hospital Santa Tecla, Tarragona, Catalonia, Spain
| | - M Isabel Alonso
- Emergency Department, Hospital Virgen de Valme, Sevilla, Spain
| | | | | | | | - Carolina Sánchez
- Emergency Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - Rosa Escoda
- Emergency Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - Adriana Gil
- Emergency Department, Short Stay Unit and Hospitalization at Home Unit, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
| | - Begoña Espinosa
- Emergency Department, Short Stay Unit and Hospitalization at Home Unit, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
| | - Desiree Wussler
- The GREAT network, Rome, Italy; Cardiology Department, University Hospital of Basel, Cardiovascular Research Institute Basel, Basel, Switzerland
| | - W Frank Peacock
- The GREAT network, Rome, Italy; Emergency Department, Baylor Medical School, Houston, Texas, USA
| | - Christian Mueller
- The GREAT network, Rome, Italy; Cardiology Department, University Hospital of Basel, Cardiovascular Research Institute Basel, Basel, Switzerland
| | - Pere Llorens
- Emergency Department, Short Stay Unit and Hospitalization at Home Unit, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
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Benito-Lozano M, López-Ayala P, Rodríguez S, Gil V, Llorens P, Yufera A, Jacob J, Travería-Becker L, Strebel I, Lucas-Imbernon FJ, Tost J, López-Hernández Á, Rodríguez B, Fuentes M, Sánchez-Ramón S, Herrera-Mateo S, Aguirre A, Alonso MI, Pavón J, López-Grima ML, Espinosa B, Mueller C, Burillo-Putze G, Miró Ò. Ambient temperature and atmospheric pressure at discharge as precipitating factors in immediate adverse events in patients treated for decompensated heart failure. Intern Emerg Med 2022; 17:2045-2056. [PMID: 36050571 DOI: 10.1007/s11739-022-03078-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 08/07/2022] [Indexed: 11/29/2022]
Abstract
To investigate the relationship of ambient temperature and atmospheric pressure (AP) at patient discharge after an episode of acute heart failure (AHF) with very early post-discharge adverse outcomes. We analyzed 14,656 patients discharged after an AHF episode from 26 hospitals in 16 Spanish cities. The primary outcome was the 7-day post-discharge combined adverse event (emergency department -ED- revisit or hospitalization due to AHF, or all-cause death), and secondary outcomes were these three adverse events considered individually. Associations (adjusted for patient and demographic conditions, and length of stay -LOS- during the AHF index episode) of temperature and AP with the primary and secondary outcomes were investigated. We used restricted cubic splines to model the continuous non-linear association of temperature and AP with each endpoint. Some sensitivity analyses were performed. Patients were discharged after a median LOS of 5 days (IQR = 1-10). The highest temperature at discharge ranged from - 2 to 41.6 °C, and AP was from 892 to 1037 hPa. The 7-day post-discharge combined event occurred in 1242 patients (8.4%), with percentages of 7-day ED-revisit, hospitalization and death of 7.8%, 5.1% and 0.9%, respectively. We found no association between the maximal temperature and AP on the day of discharge and the primary or secondary outcomes. Similarly, there were no significant associations when the analyses were restricted to hospitalized patients (median LOS = 7 days, IQR = 4-11) during the index event, or when lag-1, lag-2 or the mean of the 3 post-discharge days (instead of point estimation) of ambient temperature and AP were considered. Temperature and AP on the day of patient discharge are not independently associated with the risk of very early adverse events during the vulnerable post-discharge period in patients discharged after an AHF episode.
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Affiliation(s)
| | - Pedro López-Ayala
- Cardiology Department, Cardiovascular Research Institute Basel, University Hospital of Basel, Basel, Switzerland
| | - Sergio Rodríguez
- Estación Experimental de Zonas Áridas (EEZA), Centro Superior de Investigaciones Científicas, Almería, Spain
- Centro Superior de Investigaciones Científicas, Institute of Natural Products and Agrobiology, IPNA, Tenerife, Spain
| | - Víctor Gil
- Emergency Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, c/ Villarroel 170, 08036, Barcelona, Catalonia, Spain
| | - Pere Llorens
- Emergency Department, Short Stay Unit and Hospitalization at Home Unit, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
| | - Ana Yufera
- Cardiology Department, Cardiovascular Research Institute Basel, University Hospital of Basel, Basel, Switzerland
| | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | | | - Ivo Strebel
- Cardiology Department, Cardiovascular Research Institute Basel, University Hospital of Basel, Basel, Switzerland
| | | | - Josep Tost
- Emergency Department, Hospital de Terrassa, Barcelona, Catalonia, Spain
| | | | - Beatriz Rodríguez
- Emergency Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Marta Fuentes
- Emergency Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | | | - Sergio Herrera-Mateo
- Emergency Department, Hospital de la Santa Creu I Sant Pau, Barcelona, Catalonia, Spain
| | - Alfons Aguirre
- Emergency Department, Hospital del Mar, Barcelona, Catalonia, Spain
| | - M Isabel Alonso
- Emergency Department, Hospital Virgen de Valme, Seville, Spain
| | - José Pavón
- Emergency Department, Hospital Doctor Negrín, Las Palmas, Spain
| | | | - Begoña Espinosa
- Emergency Department, Short Stay Unit and Hospitalization at Home Unit, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
| | - Christian Mueller
- Cardiology Department, Cardiovascular Research Institute Basel, University Hospital of Basel, Basel, Switzerland
- The GREAT Network, Rome, Italy
| | | | - Òscar Miró
- Emergency Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, c/ Villarroel 170, 08036, Barcelona, Catalonia, Spain.
- The GREAT Network, Rome, Italy.
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Gil-Rodrigo A, Verdú-Rotellar JM, Gil V, Alquézar A, Llauger L, Herrero-Puente P, Jacob J, Abellana R, Muñoz MÁ, López-Díez MP, Ivars-Obermeier N, Espinosa B, Rodríguez B, Fuentes M, Tost J, López-Grima ML, Romero R, Müller C, Peacock WF, Llorens P, Miró Ò. Evaluation of the HEFESTOS scale to predict outcomes in emergency department acute heart failure patients. Intern Emerg Med 2022; 17:2129-2140. [PMID: 36031673 DOI: 10.1007/s11739-022-03068-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 07/26/2022] [Indexed: 11/29/2022]
Abstract
The HEFESTOS scale was developed in 14 Spanish primary care centres and validated in 9 primary care centres of other European countries. It showed good performance to predict death/hospitalisation during the first 30 days after an episode of acute heart failure (AHF), with c-statistics of 0.807/0.730 in the derivation/validation cohorts. We evaluated this scale in the emergency department (ED) setting, comparing it to the EHMRG and MEESSI scales in the ED and the EFFECT and GWTG scales in hospitalised patients, to predict 30-day outcomes, including death and hospitalisation. Consecutive AHF patients were enrolled in 34 Spanish EDs in January-February 2016, 2018, and 2019 with variables needed to calculate outcome scores. Thirty-day hospitalisation/death (together and separately) and post-discharge combined adverse event (ED revisit or hospitalisation for AHF or all-cause death) were determined for patients discharged home after ED care. Predictive capacity was assessed by c-statistic with 95% confidence intervals. Of 10,869 patients, 4,044 were included (median age: 83 years, 54% women). The performance of HEFESTOS was modest for 30-day hospitalisation/death, c-statistic=0.656 (0.637-0.675), hospitalisation, 0.650 (0.631-0.669), and death, 0.610 (0.576-0.644). Of 1,034 patients with scores for the 5 scales, HEFESTOS had the numerically highest c-statistic for hospitalisation/death at 30 days, 0.666 (0.627-0.704), vs. MEESSI= 0.650 (0.612-0.687, p=0.51), EFFECT=0.633 (0.595-0.672, p=0.21), GWTG=0.618 (0.578-0.657, p=0.06) and EHMRG=0.617 (0.577-0.704, p=0.07). Similar modest performances were observed for predicting hospitalisation [ranging from HEFESTOS=0.656 (0.618-0.695) to GWTG=0.603 (0.564-0.643)]. Conversely, prediction of 30-day death was good with the MEESSI=0.787 (0.728-845), EFFECT=0.754 (0.691-0.818) and GWTG=0.749 (0.689-0.809) scales, and modest with EHMRG=0.649 (0.581-0.717) and HEFESTOS=0.610 (0.538-0.683). Although the HEFESTOS scale was numerically better for predicting 30-day hospitalisation/death in ED AHF patients, its modest performance precludes routine use. Only 30-day mortality was adequately predicted by some scales, with the MEESSI achieving the best results.
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Affiliation(s)
- Adriana Gil-Rodrigo
- Emergency Department, Short Stay Unit and Hospitalization at Home Unit, Dr, Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - José María Verdú-Rotellar
- Unitat de Suport a La Recerca de Barcelona, Fundació Institut Universitari Per a La Recerca a l'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Catalan Institute of Health, Pompeu Fabra University, Barcelona, Spain
| | - Víctor Gil
- Emergency Department, Clinic Barcelona Hospital University, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, c/ Villarroel 170, 08036, Barcelona, Catalonia, Spain
| | - Aitor Alquézar
- Emergency Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Lluís Llauger
- Emergency Department, Hospital Universitari de Vic, Barcelona, Catalonia, Spain
| | | | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | - Rosa Abellana
- Unitat de Bioestadistica del Departament de Fonaments Clínics, Medical School, University of Barcelona, Barcelona, Catalonia, Spain
| | - Miguel-Ángel Muñoz
- Unitat de Suport a La Recerca de Barcelona, Fundació Institut Universitari Per a La Recerca a l'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Catalan Institute of Health, Pompeu Fabra University, Barcelona, Spain
| | | | - Nicole Ivars-Obermeier
- Emergency Department, Short Stay Unit and Hospitalization at Home Unit, Dr, Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Begoña Espinosa
- Emergency Department, Short Stay Unit and Hospitalization at Home Unit, Dr, Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Beatriz Rodríguez
- Emergency Department, Infanta Leonor University Hospital, Madrid, Spain
| | - Marta Fuentes
- Emergency Department, University Hospital of Salamanca, Salamanca, Spain
| | - Josep Tost
- Emergency Department, Consorci Hospitalari de Terrassa, Barcelona, Catalonia, Spain
| | | | - Rodolfo Romero
- Emergency Department, University Hospital of Getafe, Universidad Europea, Madrid, Spain
| | - Christian Müller
- Cardiology Department, University Hospital of Basel, Cardiovascular Research Institute Basel, Basel, Switzerland
- The GREAT Network, Rome, Italy
| | - WFrank Peacock
- Emergency Department, Baylor School of Medicine, Houston, TX, USA
- The GREAT Network, Rome, Italy
| | - Pere Llorens
- Emergency Department, Short Stay Unit and Hospitalization at Home Unit, Dr, Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Òscar Miró
- Emergency Department, Clinic Barcelona Hospital University, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, c/ Villarroel 170, 08036, Barcelona, Catalonia, Spain.
- The GREAT Network, Rome, Italy.
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